title: Retrospective evaluation of the clinical necessity of external biliary drainage after pancreaticoduodenectomy.
abstract: OBJECTIVE
  To evaluate the efficacy of internal biliary drainage after pancreaticoduodenectomy (PD), postoperative gastrointestinal function and complications of PD were compared in patients with and without the use of an external drainage stent for hepaticojejunostomy (HJ).
  
  
  METHODS
  Between June 2005 and September 2011, 66 patients who underwent PD, including 40 patients with externally-stented HJ (ES group) and 26 patients with non-stented HJ (NS group), were included in this study, and postoperative bowel movements, oral intake, and complications were assessed.
  
  
  RESULTS
  Time to tolerance of water or solid food were comparable between the two groups, and time to first bowel movement was significantly shorter in the NS group than in the ES group (3.2 +/- 1.6 days versus 4.6 +/- 1.7 days; p = 0.002). There were no differences in the incidence and severity of postoperative complications when comparing the two groups, whereas the incidence of postoperative cholangitis was significantly higher in the ES group (25.0%) than in the NS group (3.8%; p = 0.024).
  
  
  CONCLUSIONS
  External biliary drainage may have a negative impact on biliary complications after PD, especially on the incidence of postoperative cholangitis.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Imai
authors.forename: Shinji
authors.initials: S
authors.lastname: Osada
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Tanahashi
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Naoki
authors.initials: N
authors.lastname: Okumura
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Matsuhashi
authors.forename: Kenichi
authors.initials: K
authors.lastname: Nonaka
authors.forename: Michitaka
authors.initials: M
authors.lastname: Nagase
authors.forename: Takao
authors.initials: T
authors.lastname: Takahashi
authors.forename: Kazuya
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D000368:Aged; D002761:Cholangitis / Q000453:epidemiology; D004322:Drainage / Q000295:instrumentation; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D041781:Jaundice, Obstructive / Q000601:surgery*; D007582:Jejunostomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D020127:Recovery of Function; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome